IMMANUEL FAMILY PRACTICE NPI 1164487823

NPI Information

  • NPI: 1164487823
  • Provider Name: IMMANUEL FAMILY PRACTICE
  • Classification: Clinic/Center - 261QM2500X
  • Specialization: Medical Specialty
  • Entity Type: Organization
  • CLIA Number: 34D1031665
  • Address: 5500 W FRIENDLY AVE
    SUITE 201
    GREENSBORO, NC
    ZIP 27410
  • Phone: (336) 856-9996

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NPI Details

IMMANUEL FAMILY PRACTICE is a medical specialty clinic center in Greensboro, NC. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). IMMANUEL FAMILY PRACTICE NPI is 1164487823. The provider is registered as an organization entity type.

The provider's business location address is:

5500 W FRIENDLY AVE
SUITE 201
GREENSBORO, NC
ZIP 27410-212
Phone: (336) 856-9996

The provider's authorized official is Betti D Reese .
The authorized official title is President and has the following contact phone number (336) 856-9996.

The CLIA number assigned to this NPI record is 34D1031665 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 12/10/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12340461MEDICARE PINNORTH CAROLINA
289016JVMEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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